发散式冲击波联合手法治疗桡骨茎突狭窄性腱鞘炎

Divergent blast wave combined with manipulation in treatment of stenosing tenosynovitis of radial styloid

目的观察发散式冲击波联合手法对桡骨茎突狭窄性腱鞘炎的治疗效果。方法选择2015年8月至2017年1月安徽医科大学第二附属医院康复医学科治疗桡骨茎突狭窄性腱鞘炎患者35例,其中男性9例,女性26例;年龄25~65岁,平均年龄44.6岁。随机分为治疗组和对照组。治疗组18例,其中男性4例,女性14例;年龄(43.5±4.8)岁;病程(2.1±1.3)个月。对照组17例,其中男性5例,女性12例;年龄(45.2±5.6)岁;病程(1.9±1.1)个月。对照组采用常规手法治疗,治疗组在手法治疗的基础上加用发散式冲击波治疗。比较两组患者治疗前、治疗1周后、2周后的疼痛视觉模拟量表(VAS)评分、患者自我腕关节功能评价(PRWE)评分,并评价1个月后两组的疗效。结果治疗1周后和2周后治疗组VAS评分分别为(2.5±1.2)分、(1.7±0.6)分,PRWE评分分别为(48.3±4.2)分、(21.2±2.6)分;较治疗前明显改善,差异有统计学意义(P<0.05);对照组VAS评分分别为(5.4±1.1)分、(3.9±1.2)分,PRWE评分分别为(63.1±6.7)分、(45.7±7.4)分。治疗组优于对照组,差异有统计学意义(P<0.05)。对照组1周后VAS评分及PRWE评分较治疗前无明显改善(P>0.05),2周后VAS评分及PRWE评分较治疗前明显改善,差异有统计学意义(P<0.05);治疗组1个月后有效率及痊愈率均高于对照组(89%vs 76%、56%vs 29%),差异均有统计学意义(P<0.05)。结论冲击波联合手法治疗可有效促进桡骨茎突狭窄性腱鞘炎患者损伤部位的修复,能快速减轻疼痛、改善腕部功能。

Objective To observe the clinical efficacy of divergent blast wave combined with manipulation therapy in the treatment of stenosing tenosynovitis of radial styloid. Methods From August 2015 to January 2017, a total of 35 stenosing tenosynovitis of radial styloid patients were enrolled, which included 9 males and 26 females, aged 25-65 years old with mean age of 44.6 years old. All of them were randomly divided into treatment group[n = 18, included 4 males and 14 females;aged（43.5 ± 4.8） years old; course of（2.1 ± 1.3） months] and control group[n = 17, included 5 males and 12 females; aged（45.2 ± 5.6） years old; course of（1.9 ± 1.1） months]. The control group was treated conventional manipulation, and besides conventional manipulation treatment group was treated divergent blast wave treatment. The visual analogue scale（VAS） scores and patient-rated wrist evaluation（PRWE） scores before treatment, after treatment 1-week and 2-week were compared be-tween 2 groups, and evaluated the effect after 1-month between 2 groups. Results After treatment 1-week and 2-week, the VAS in treatment group was（2.5 ± 1.2） scores and（1.7 ± 0.6） scores, PRWE was（48.3 ± 4.2） scores and（21.2 ± 2.6） scores, which were significantly improved, and the difference was statistically significant（P〈0.05）; the VAS in control group was（5.4 ± 1.1） scores and（3.9 ± 1.2） scores, PRWE was（63.1 ± 6.7） scores and（45.7 ± 7.4） scores. The treatment group was superior to control group,and the difference was statistically significant（P〈0.05）. After treatment 1-week, there was no significant improvement of VAS and PRWE scores in control group（P〉0.05）. Compared with before treatment, the VAS and PRWE scores after treatment 2-week significant improved, the difference was statistically significant（P〈0.05）; After treatment 1-month, the effective rate and recovery rate of treatment group were higher than those of control group（89 % vs 76 %, 56 % vs 29 %）, the difference was statistically significant（P〈0.05）. Conclusion It is demonstrated that divergent blast wave combined with manipulation could effectively promote the repair of injured parts of patients with stenosing tenosynovitis of radial styloid, and alleviate the pain and improve wrist function rapidly.